Summary Report October 2014
Prepared for CLeAR Faculty, Clinical Advisory Group and Action & Improvement Teams
Purpose of this Report
This report is prepared for the CLeAR Faculty and Clinical Advisory Group and summarizes the results and methods that are being used to measure the progress of the CLeAR Initiative. It is also shared with Action and Improvement Teams via the CLwK site.
Aim
Achieve a reduction of 50% in the inappropriate use of antipsychotics in participating facilities across the province through evidence‐based management of the behavioural and psychological symptoms of dementia (BPSD) for seniors living in residential care by December 31, 2014.
Results to Date
Below is an aggregate of results to date of teams reporting data to CLeAR.
In addition, it’s important to note that these aggregate data alone do not reflect the progress teams are demonstrating. As is the population in a residential care facility, the denominator in the above measures is not static. In particular, new admissions into the facility are often on antipsychotics, increasing the
denominator. In addition, staff can work hard to stop antipsychotics for a resident but when that resident dies, he/she is removed from the numerator. Also, these measures do not take into account the number of residents that may be on a reduced dosage.
Provincial ALL: % of residents prescribed an antipsychotic within participating facilities submitting reports and is calculated by counting the total number of residents prescribed any type of antipsychotic divided by the total number of residents.
Provincial Any Regular: the % of residents on an antipsychotic prescribed to be given regularly in participating facilities submitting reports and is calculated by counting the total number of residents with an ordered regularly given antipsychotic divided by the total number of residents.
Provincial Any PRN: the % of residents with an antipsychotic prescribed to be given PRN in the participating facilities submitting reports and is calculated by counting the total number of residents with a PRN antipsychotic divided by the total number of residents.
Provincial Both PRN and Regular: the % of residents with both PRN and regular antipsychotics prescribed in the participating facilities submitting reports and is calculated by counting the total number of residents with both PRN and regular antipsychotics divided by the total number of residents.
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Percent of residents prescribed to receive any anti‐psychotic:
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Percent of residents prescribed to receive an anti‐psychotic regularly:
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Percent of residents prescribed to receive an anti‐psychotic PRN:
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Percent of residents prescribed to receive an anti‐psychotic both regularly and PRN:
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CLeAR Improvement Teams Activity and Individual Success Stories
Even with the measurement challenges noted above, some individual facilities have seen a dramatic improvement. We are seeing several “early adopter” facilities that have made significant progress in reducing their use of anti‐psychotics. Below are twelve examples of facilities with reductions in ANY antipsychotic use, many of these facilities have achieved greater than 50% reduction:
Several teams have started tracking “Percentage of Residents on a Reduced Dose” as even small
reductions in the use of antipsychotics can lead improvements in quality of life. Also, those teams that have had a net inflow of residents on antipsychotics from other parts of the healthcare system are tracking “Number of New Admissions on an Antipsychotic” to put their outcome data in context and take actions at appropriate points in the process.
PRN antipsychotics tend to be used less frequently than regular doses, as most facilities started the CLeAR initiative with less than 20% of their residents on a PRN antipsychotic. However, this isn’t the case in all facilities and some teams focused their work on removing these.
The majority teams are trying a number of changes, multiple changes at once and often focusing on
foundational work by educating staff, improving culture, doing PIECES training, and testing non‐
pharmacological strategies with residents. Below are just a few examples:
Cedarview Lodge has learned that sharing information is a key for success, so they are working on staff/family education about dementia in order to avoid/prevent trigger events and reduce residents’ distress reactions.
Three Links Care Centre has found the information gathered in the “Getting to Know Me” form has helped when developing residents’ care plans. This information has also been useful for visitors, and made it easier for them to start a conversation and engage the resident.
Pinegrove Place has continued a focus on education having staff attend a one day session on managing/preventing aggressive behaviours, which they found very beneficial. The team is also trying a new approach to sharing information between facility staff and the Richmond Mental Health team, which will be evaluated.
Glacier View Lodge has tested and developed a new template in their E charting system for RCAs to complete to help enhance assessments. The trial has been going very well, and had the additional benefit of educating staff on assessing triggers and identifying successful interventions.
CLeAR Activities and Support
Webinars:
October 7th “Managing Admissions”
o Presentation by Dena Kanigan, Director of Care and Special Projects at Castleview Care Centre
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Site 2
October 21st “Non‐Pharmacological Interventions for BPSD”
o Presentations by Janice Vance, CLeAR faculty member, and Jennifer Brett, Clinical Nurse Educator at Eagle Ridge Manor
Site Visits:
Improvement Advisors completed their fall site visits in October. Between September and October, IAs completed close to 20 site visits ranging from discussions with individual teams to 4‐hour workshops with a group of CLeAR sites. These site visits provided an opportunity to learn about what has been working for teams, as well as more about challenges they’re facing. These visits usually concluded with a discussion about the sustainability of CLeAR work and what teams can do to make CLeAR part of the new norm.
Optional Data Collection Tool:
Building on the trial of additional measures during the summer, an Optional Data Collection Tool was created for teams to use with additional measures: reduced dose tracking and new
admissions
Various teams continued to use this Optional Data Collection Tool to submit their outcome measures, as well as these new additional measures
Please see below for a couple examples of graphs for these new measures
High Impact Changes / Enablers for Success:
A Driver Diagram worksheet with “High Impact Changes” highlighted was shared with the CLeAR team and faculty for feedback, and an updated working version is now available on CLwK
BPSD Algorithm and PPOs:
Based on feedback from the working group, a Practice Recommendations document for using antipsychotic medications has been developed by adapting the Interior Health Pre‐Printed Orders documents (this document is available on CLwK)
The BPSD Algorithm working group is developing a case study that ties in elements of the BPSD algorithm and PIECES training that teams will be able to use. The initial version of this case study was used during a mini‐workshop at Mission Memorial with several CLeAR teams.
CLwK:
The chart below shows page views on CLwK CLeAR pages. This is a measure of engagement on CLwK. Peaks in ClwK activity coincide with webinars and newsletter releases. Some statistics:
o Black line: weekly page views ranged from 35‐627 (median 182).
TRUE #N/A TRUE #N/A
FALSE 8 FALSE 1
FALSE 15 FALSE 5
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Number of new admissions and new admissions on antipsychotics
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20 New Admissions
New Admissions on Antipsychotic
TRUE #N/A TRUE #N/A TRUE #N/A TRUE #N/A TRUE #N/A TRUE #N/A TRUE #N/A TRUE #N/A TRUE #N/A TRUE #N/A 35% FALSE 35%
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51% FALSE 51%
TRUE #N/A
Percent of residents on an antipsychotic with a reduced dose
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o Red line: weekly unique (user) page views ranged from 21‐179 (median 56).
Newsletter:
We continue to send monthly newsletters to engage teams, share resources and information about upcoming webinars, spread inspirational stories and circulate news related to CLeAR.
Currently 211 people receive our newsletter – a figure that includes everyone who signed up as Action & Improvement Team, Individual and Organizational Partner members. Newsletters are supplemented by email messages from CLeAR and improvement advisors.
In the chart below, “open rate” represents the percentage of subscribers who read a newsletter, and “click rate” is the percentage of subscribers who clicked a link. While both of the rates’
averages are higher than those of industry averages, there are opportunities to examine possible reasons why readership has lowered since the summer and become inconsistent.
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Newsletter Performance
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